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�Rpk IFI,! n , $AN ��AQU � �� Environmental HealthDepartment COUNTY Greatness groes here. 9 Water Usage Information PROJECT INFORMATION Application Number: Application Type: Use Permit Project Address: 16201 N.Tretheway Road,Lodi CA.95240 Project APN: 05120053 Applicant Name: Cookstone Estate Winery Title: Applicant Address: 16201 N.Tretheway Road City/Zip: Lodi CA.95240 Applicant Phone:1(209)610-9973 Email: bcook@silverstateblending.com Property Owner Name: Bill A.Cook,Jr.and Robin C.Cook,Trustees of The Cook Family Living Trust Dated 3/25/94 Property Owner Address: 16201 N.Tretheway Road City/Zip:I Lodi CA.95240 Property Owner Phone: (209)610-9973 I Email:I bcook@silverstateblending.com SERVICES INFORMATION Please provide description below: Water Supply: ❑ Surface Water(Attach Water Rights Information) Domestic Wastewater Disposal: septic Process Wastewater Discharge: Ponds: Applicable WDR: Storm Drainage System: Natural Drainage WATER USAGE DATA Provide for total water usage at full buildout Number Persons/Day Gallons/Person/Da Total Gallons/Da Domestic Water Usage by Employees/Customers: N/A Type of Process/Irrigated Lands Total Gallons/Da Process Water Usage: Process Water Usage: irrigation Water Usage: Total Gallons Per Day: PROPOSED WELL LOCATION Well Location Address: N/A Cit j Well Location APN: Well Latitude: Well Longitude:1 Flood Plain Designation: Well Elevation: PROPOSED WELL INFORMATION Well Total De th(ft):l Acres to be Served by Well: Use of Well: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock ❑ Other: Depth of Corcoran Clay(ft): Proposed Well Capacity(gal/ft):l I Estimated Pumping Rate(gal/min): Anticipated Pumping Schedule(gal/day):l I(gal/day): Estimated Annual Extraction Volume(acre-feet): Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): SITING INFORMATION Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: Wastewater Treatment System: Sources of Contamination: Other Wells: Pond/Lake: Sewer Lines: Stream/River: Animal or Fowl Enclosure: Navigable Waterway:. Storm Drainage System: Potential Recharge Features: GROUNDWATER INFORMATION Depth(ft): Source/Date of Reference: Groundwater Subbasin: Current Depth to Water: 113 California Water Data Library ❑ Cosumnes Subbasin(2-22.16) Highest Depth to Water: 120 California Water Data Library a Eastern San Joaquin Subbasin(5-22.01) Lowest Depth to Water: 47.32 California Water Data Library ❑Tracy Subbasin (5-22.15) 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wwv.sjcehd.com 1 of 2